The operational change behind the reported reduction in waiting time
A referral route built around clinical need rather than one appointment type
An October 7, 2026 report from the Ontario Medical Association describes a process redesign at the mental health unit of St. Thomas-Elgin General Hospital in Ontario. Its chief of psychiatry and medical director, Dr. Giuseppe Guaiana, said the outpatient service previously had roughly 160–170 patients waiting for psychiatrist appointments and waits of about ten months. Following the introduction of a triage and telephone consultation system, he reported waits of four to six weeks (Ontario Medical Association, 2026).
The key change was to examine the assumption that every referred patient needed the same full in-person specialist appointment. The redesigned pathway assigned a social worker to triage referrals and provided clinical escalation where a decision was uncertain. For lower-risk cases, a psychiatrist could hold a brief, usually ten-minute telephone consultation with the referring family physician, offer recommendations when appropriate or arrange an in-person assessment for cases needing it. Clinical staff retained responsibility for determining the suitable route.
This is a strong example of process improvement because it changes the design of demand flowing through a constrained service. The service did not simply ask clinicians to work faster. It changed how different needs entered and used specialist capacity. The reported result is substantial, but the OMA article presents a local practitioner account, not evidence that triage alone caused every part of the reduction or that the same pathway would be appropriate in another hospital.
What the bottleneck looks like in process terms
A queue develops when arrivals and the capacity required to process them are poorly matched. If each referral competes for the most time-intensive appointment, suitable lower-intensity interactions may wait behind cases with very different needs. Creating clinically appropriate pathways can alter the mix of specialist work and reserve scarce appointment capacity for cases that require it. In administrative operations, the parallel could be routing straightforward applications to a verified fast path while complex exceptions receive more expert review.
The transferable concept is segmentation with explicit decision rules, not a recommendation for non-clinicians to judge medical severity. Any clinical design must be governed by qualified professionals and protect patient safety. In a business setting, the corresponding questions are who can classify incoming work, which evidence they need, which cases may use a simpler route and what triggers immediate escalation. The risk of a fast route is that an incorrectly classified case can be more damaging than the time saved.
Figure 1. A general improvement testing framework, not a clinical protocol.
How to redesign a waiting-time process responsibly
Map the queue before choosing the new pathway
First identify when the customer begins waiting and when the service actually delivers a useful outcome. Separate the time spent in a queue from touch time, and plot different categories of requests instead of relying only on an overall average. An overall improvement could hide a deterioration for high-complexity or vulnerable cases. Measure both the typical wait and its spread, including the longest waits, along with arrivals, backlog, available capacity, rework and referrals returned for more information.
Next examine why different requests currently receive the same treatment. Is the decision driven by a rule, system limitation, perceived fairness or habit? Some standardisation is necessary for safety and consistency; excessive standardisation can also require more expertise than a task needs. A proposed segmented route should document the intended decision criteria, eligible categories, fallback arrangements, specialist review and accountability for errors.
Test an alternative and monitor unintended consequences
A small, time-limited test is generally more informative than changing every queue at once. Specify in advance how requests will be selected, what staff will record, and what will count as success or a stop condition. The Institute for Healthcare Improvement distinguishes outcome measures, process measures and balancing measures. For this kind of redesign, those might be waiting time, time to triage and the rate of inappropriate routing or unplanned escalation, respectively (IHI, n.d.).
A further concern is implementation. Dr. Guaiana reported that some referring family physicians disliked the new approach or felt it was imposed on them. That detail matters because the performance of a redesigned process depends on people outside the immediate team. A technically sensible route can fail when its users do not understand the aim, cannot provide the required inputs or do not trust the escalation method. Regular feedback and adjustment therefore belong in the process design itself.
The OMA report also notes that the team published a scientific paper about the initiative. The article by Guaiana, Coffey and Haykus appeared online in July 2026 under the title “Reducing Outpatient Psychiatry Wait Times Through Structured Triage and Telephone Consultation: A Quality Improvement Initiative.” That separate publication provides a further source for readers who wish to examine the initiative’s documented methods and limitations.
The wider process improvement lesson
Improve the decision that allocates capacity
Many improvement teams start at the busiest activity and ask how to accelerate it. The more valuable question may be whether every request needs that activity at all. This principle applies to service desks, permit applications, procurement approvals, maintenance scheduling and customer complaints. Each example needs its own risk checks, but all benefit from understanding the demand, designing decision rules and matching the response to actual requirements.
A useful process improvement practitioner can identify that distinction, test it with evidence and measure the whole-system result. Those are central capabilities in STEP Bootcamp, which teaches participants to identify problems, analyse causes, design improvements and prove value through practical assignments. Its 28-day format includes four live sessions and personalised feedback rather than relying only on theory.
Use training to make sound routing decisions repeatable
Employers with multiple teams or complex customer-facing operations may need a shared way to map service pathways, spot constraints and evaluate changes without compromising quality or compliance. STEP Corporate Training offers customised process improvement training that can be adapted to the organisation’s processes, duration, schedule and delivery requirements. The aim should be to build employees’ ability to redesign and control a process responsibly, not to reproduce a hospital’s clinical model outside its context.
The Ontario case is useful because the improvement idea was both specific and consequential: reconsider whether different needs genuinely require the same pathway. A good continuous improvement system enables employees to ask that question, document their reasoning, test the answer and keep watching for the effects after implementation.
References
Guaiana, G., Coffey, L. & Haykus, E. (2026, published online 31 July). Reducing Outpatient Psychiatry Wait Times Through Structured Triage and Telephone Consultation: A Quality Improvement Initiative. DOI: 10.1007/s10597-026-01702-w — https://pubmed.ncbi.nlm.nih.gov/42536132/Institute for Healthcare Improvement. Model for Improvement: Establishing Measures — https://www.ihi.org/library/model-for-improvement/establishing-measures
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